Chronic Cough: Evaluation and Management

Chronic cough is a cough lasting longer than 8 weeks in adults and 4 weeks in children. In the United States, more than 12.3 million individuals are estimated to have chronic cough. The most common causes of chronic cough in adults are upper airway cough syndrome, asthma, nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and laryngopharyngeal reflux. The initial assessment of chronic cough should include cost-effective diagnostic tests, such as chest radiography and spirometry, and empiric and targeted treatment for the most common etiologies. An assessment of medications (e.g., angiotensin-converting enzyme inhibitors), environment, occupation, and potential chemical triggers should be conducted. For chronic refractory cough, physiotherapy and speech and language therapy combined with a trial of gabapentin or amitriptyline can be considered. When initial test findings are unremarkable, further diagnostic tests, such as bronchoscopy and nasendoscopy, are often warranted through referral to a pulmonologist and otolaryngologist. Common etiologies in children include protracted bacterial bronchitis, asthma, bronchiectasis, upper airway cough syndrome, and gastroesophageal reflux disease. Because of the high likelihood of spontaneous resolution, children with a dry cough without wheezing or exertional dyspnea may be observed for 2 weeks.